Rescue+Intermezzo+Quintessenza+Internazionale+September October+2008

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Q U I N T E S S E N Z A I N T E R N A Z I O N A L E

SETTEMBRE-OTTOBRE2008 A N N O 2 4

N U M E R O 5 b i s

Clinically relevant, scientifically based

QUINTESSENZA EDIZIONI S.r.l. - Via Ciro Menotti 65 - 20017 Rho (Mi) - Sped. in abb. post. D.L. 353/2003 (conv. in L. 27/02/04 n. 46) art. 1 comma 1, DCB - Milano

Speciale

implantologia2008Spe

ciale

implantologia2008

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The increased use of short dental implants is an emerging trend in the literature today. The aim of this study is to assess a number of articles to be able

to draw conclusions for our own day to day clinical use. Twenty patients were selected and 32 implants were placed in both maxillary and mandibular

bone. Single crowns or part bridges were the planned prostheses. The implant survival rate was about 97%. A single implant, placed in the maxillary tuberos-

ity area, failed during the second stage surgery.

Key words: Short implants, alternative to regeneration, crown-root ratio.

QUINTESSENZA INTERNAZIONALE

INTRODUCTION

Beginning with the pioneer work of Brne-

mark, one of the fundamental dogmas of im-

plantology has been the placement of the

longest possible dental implants possible in re-

lation to the amount of available bone. This was

the beginning of the phase of implantology

(surgically driven implantology) based on os-

seo-integration and the use of smooth-surface

machined implants. Since then technologi-

cal development supported by research and

clinical activity have brought about continuous

changes in indications and have extended the

boundaries of implant-prosthetic therapy.

In particular, surface treatments, modifica-

tions to the implant design and surgical tech-

niques have allowed a progressive use of im-

plants of decreasing length1. Back in 1998, ten

Bruggenkate published the results of a multi-

centre study on the use of 6mm implants. Lat-

er, Deporter reported on the results of short

implants with modified porous surface implants

in both the maxillary bone and in mandibular

bone2-5. In the recent literature, the use of short

implants with a minimum length of 5mm and

with wide diameters (wide diameter implants) is

now emerging6-25. The minimum requirement

of 10 mm of length for an implant to be suc-

cessful has now been surpassed6. In the case

of short implants, the reduction in length is

compensated for by a concommitant increase

in diameter, in many cases reaching a surface

available for osseo-integration that is compara-

ble to standard implants. A standard implant

of 10 mm in length and 4 mm in diameter pro-

vides a surfaces area of about 152 mm2 whilst

an implant 6 mm in length and 5 mm in diam-

eter provides a surface of about 150 mm2. From

a biomechanical point of view, the increase in

the implant diameter also determines a parallel

increase in the size and rigidity of the entire sys-

tems components. The size of the abutment,

the connection and abutment screw all increase

thereby reducing the incidence of unscrewing

and/or fractures at this level. Considering the

fact that these implants are essentially used in

the posterior regions, the notable stress from

cyclical fatigue to which the mechanical compo-

nents are subjected can be addressed.

Finally, the increased diameter of the im-

plant platform allows crowns to be created with

an adequate emergence profile that is closer to

the normal size of a multi-rooted tooth.

Matteo Sartori*, Riccardo Monguzzi*, Salvatore Longoni**, Kwang Bum Park***, Massimo Mingardi****,

Marco Baldoni*****

Short implants: an alternative treatment option

* PhD research student in Experimental Periodontology,

University of Milano-Bicocca.

** Specialist in Oral Surgery, Contract Professor in Prostheses

Prosthetics, University of Milano-Bicocca.

*** Independent Professional. President of the MIR Dental Hospital

Daegu, Korea.

**** PhD research graduate in Experimental Periodontology,


***** Head of the Department of Neuro-sciences and Biomedical

Technologies, University of Milano-Bicocca.

Address for correspondence:

Matteo Sartori

Universit degli Studi di Milano-Bicocca, Via Cadore 48 Monza (MI)

Tel. +39 2 96720909 - Fax. +39 2 96328554

E-mail: [email protected]

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When a standard diameter implant is used

to replace the wide mesio-distal space left by

the loss of a molar, the emergence profile of the

crown must be modelled following unnatural

profiles, mediating between two opposing clin-

ical situations: either a linear profile that direct-

ly joins the narrow implant platform to the mar-

ginal crest, leaving a wide, triangular interprox-

imal space that is uncomfortable for the pa-

tient, or a profile that tries to fill in the interprox-

imal space as well as possible, progressing

first horizontally and then vertically. Another

option is to use two standard implants that are

restored with a single crown. Often however

the space available is too much for a single im-

plant and too small for two implants. In both the

case of an excess cervical prosthetic profileand in the positioning of two implants, profes-

sional and home hygiene maintenance will be

difficult and probably compromised.

In the past, the wide fixture was essentially

designed and used as a rescue implant, as an

emergency solution if it was necessary to make

the implant site oval in poor quality bone (type

IV) or if failed standard implants had to be re-

placed immediately7. Nowadaysthe indications

for the use of short implants have increased:

1. Patients general health linked to age, pres-

ence of systemic pathologies, use of phar-

maceuticals, presence of local oral condi-tions preventing advanced surgical tech-

niques for the vertical regeneration of

mandibular bone tissue or the lifting of the

maxillary sinus.

2. To avoid complex regenerative surgery with

a possible increase in early or delayed com-

plications.

M. Sartor i , R . Monguzz i , S . Longoni , K . B. Park , M. Mingardi , M. Ba ldoni

3. Clinical situations in which a partial failure of

tissue regeneration has occurred.

In all cases it is necessary to remember and

therefore warn the patient that prosthetic reha-

bilitation on short implants often creates longer

crowns, which will therefore appear longer than

the natural adjacent teeth.

INDICATIONS FOR THE USEOF SHORT IMPLANTS

The use of short implants has allowed rapid

rehabilitation of partial edentulism in patients

with healing times that are comparable with

those of standard implants with modified sur-faces i.e. two months in the mandible and three

months in the maxilla.

Of course, to obtain success in using short

implants, some rules should be observed.

Increase in diameter

Short implants are characterised by wide di-

ameters to compensate for the reduction in length

and to present an extensive overall surface for os-

seo-integration. The recommendation is to

choose an implant with the widest possible diam-

eter in relation to the tooth to be rehabilitated and

the residual bone available. The presence of atleast 1 mm of bone around the implant is need-

ed to ensure adequate blood supply of the resid-

ual bone that supports the implant, thus avoiding

the undesired phenomena of resorption26.

Surface treatment

Modern modified implant surfaces allow the

correct stability of the coagulum on the implant

body. A short implant can only guarantee per-

formances that are comparable to standard

length and diameter implants if they have a mod-

ified, larger surface than a machined surface

implant1.

Internal connection

In most case internal connection short im-

plants are preferred to the use of external con-

nection implants. Internal connection means

the surface treatment can be extended to in-

clude the platform, up to the external perimeter

of the connection area. This results in osseo-in-

tegration on the upper surface of the implant

body and once healing is completed, the im-

plant will be locked inside a closed bone struc-

ture (apical part, lateral walls and upper por-tion) that effectively combats lateral stress.

Platform switching

The use of abutments with a reduced diam-

eter base compared to the diameter of the im-

plant platform allows horizontal space to be

gained, in order to manage biological width, re-

ducing the loss of vertical bone in the ridge

area27.

Increase in number of implants

If short implants are used, it is preferable to

increase the number of implants, inserting onefor each tooth to be restored, thereby avoiding

bridges with intermediate elements6.

Splinting of implants

Splinting of implants is also recommended

i.e. by planning crowns that are joined together

to reduce the effect of lateral stress6.

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MATERIALS AND METHODS

32 short implants with an internal connection

(Rescue

Internal, Megagen Co, Ltd, South Ko-rea) were inserted in the latero-posterior sec-

tors of the maxillary bone and in the mandible

of 20 patients: 8 males and 12 females aged be-

tween 45 and 70 years of age, with an average

age of 60.2 years were treated. The length of the

implants ranged between 5 and 7.5 mm with a

diameter of between 6 and 8 mm. The implants

were restored with single crowns or with partial

bridges (figures 1-7).

The reasons that brought about the choice

of a short implant differed depending on the

clinical case. In 13 patients, it was impossible to

carry out advanced surgery for the vertical re-generation of bone tissue, due to general health

problems (figures 8-11). Four patients, although

they had no general medical problems, refused

the complexity and duration of the treatment

plan that required regeneration and the associ-

ated risks connected with it. In 2 cases, a previ-

ous implant failure was resolved (Figures 12-

15). Finally, in 1 case, the patient was rehabilitat-

ed after the partial success of a mandibular re-

generation.

The follow-up lasted from 6 to 14 months

from the loading of the final prosthesis. Implant

survival was about 97%, as 1 implant inserted

into quality IV bone in the maxillary tuberosity

area failed during the second stage procedure,

with clinical evidence that no osseo-integration

had taken place in this single case.

Fig. 1 Surgical phase: evaluation of bone ridge. Fig. 2 Preparation of implant bed using a trephine cutter/bur.

Fig. 3 Removal of bone core. Fig. 4 Correction of implant bed.



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Fig. 5 Insertion of implant: diameter 6 mm and length 7 mm.Fig. 6 View of soft tissues before prosthesization. Fig. 7 Check-up endoral radiography: follow-up at13 months.

Fig. 8 Preparation of implant bed using a trephine cutter. Fig. 9 Insertion of implant: diameter 6 mm and length 7 mm. Fig. 10 Final prosthesis: follow-up at 8 months.



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Fig. 11 Check-up endo-oral radiography: follow-up at 8 months. Fig. 12 Surgical phase: removal of a fractured standardimplant in the mandible. Fig. 13 Revision of implant bed using a correction bur.

Fig. 14 Suitability between implant bed and positionedimplant.

Fig. 15 Check-up endo-oral radiography: follow-up at 10months.


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CONCLUSIONS

Short implants are a valid treatment modal-

ity and option if one wishes to avoid more so-phisticated, invasive regenerative surgery due

to clinical reasons or if the patient does not

wish to undergo such surgery. These implants

allow us to provide implant-retained restora-

tions in areas characterised anatomically by

the presence of structures such as the

mandibular canal and the maxillary sinus.

The limited current follow-up has only al-

lowed us to carry out only a preliminary evalu-

ation, and does not take into account the pos-

sible failure of these implants.

BIBLIOGRAPHY

1. Bernard JP, Szmukler-Moncler S, Pessotto S, Vazquez L,

Belser UC. The anchorage of Brnemark and ITI implants

of different lengths. I. An experimental study in the ca-

nine mandible. Clin Oral Implants Res 2003;14:593-600.

2. ten Bruggenkate CM, Asikainen P, Foitzik C, Krekeler G,

Sutter F. Short (6-mm) nonsubmerged dental implants:

results of a multicenter clinical trial of 1 to 7 years. Int J

Oral Maxillofac Implants1998;13:791-798.

3. Deporter D, Todescan R, Caudry S. Simplifying manage-

ment of the posterior maxilla using short, porous-sur-

faced dental implants and simultaneous indirect sinus

elevation. Int J Periodontics Restorative Dent 2000;

20:476-85.

4. Deporter D, Pilliar RM, Todescan R, Watson P, Pharoah M.

Managing the posterior mandible of partially edentulous

patients with short, porous-surfaced dental implants:

early data from a clinical trial. Int J Oral Maxillofac Im-

plants 2001;16:653-658.

5. Hagi D, Deporter DA, Pilliar RM, Arenovich T. A targeted

review of study outcomes with short (7 mm) en-

dosseous dental implants placed in partially edentulous

patients. J Periodontol 2004; 75:768-804.

6. Misch CE, Steigenga J, Barboza E, Dietsh F, Ciancila LJ, Ka-zor C. Short dental implants in posterior partial eden-

tulism: a multi center retrospective 6-year case series

study. J Periodontol 2006;77:1340-1347.

7. Langer B, Langer L, Hermann I, Jorneus L. The wide fix-

ture: a solution for special bone situations and a rescue

for the compromised implant. Part 1. Int J Oral maxillo-

fac Implants 1993;8:400-8.

8. Texeira ER, Wadamoto M, Akagawa Y, Kimoto T. Clinical

application of short hydroxylapatite-coated dental im-

plants to the posterior mandible: a five-year survival

study. J Prosthet Dent 1997;78:166-171.

9. Ivanoff CJ, Grndahl K, Sennerby L, Bergstrm C, Lekholm

U. Influence of variations in implants diameters: a 3-to5-

year retrospective clinical report. Int J Oral Maxillofac Im-

plants 1999;14:173-80.

10. Stellingsma C, Meijer HJ, Raghoebar GM. Use of short

endosseeous implants and an overdenture in the ex-

tremely resorbed mandible: a five-year retrospective

study. J Oral Maxillofac Surg 2000;58:382-387.

11. English C, Bahat O, Langer B, Sheets CG. What are the clin-

ical limitations of wide-diameter (4 mm or greater) root-

form endosseous implants? Int J Oral maxillofac Implants

2000;15:293-6.

12. Davarpanah M, Martinez H, Kebir M, Etienne D, Tecu-

cianu JF. Wide-diameter implants: new concepts. Int J Pe-

riodontics Restorative Dent 2001;21:149-59. Review.

13. Friberg B, Ekestubbe A, Sennerby L. Clinical outcome of

Brnemark system implants of various diameters: a retro-

spective study. Int J Oral Maxillof Implants 2002;17:671-7.

14. Artzi Z, Parson A, Nemcovsky CE. Wide-diameter implant

placement and internal sinus membrane elevation in

the immediate postextraction phase: clinical and radi-

ographic observations in 12 consecutive molar sites. Int

J Oral Maxillofac Implants 2003;18:242-9.

15. Tawil G, Younan R. Clinical evaluation of short, machined-

surface implants followed for 12 to 92 months. Int J Oral

Maxillofacial Implants 2003;18:894-901.

16. Nedir R, Bischof M, Briaux JM, Beyer S, Szmucler-Moncler

S, Bernard JP. A 7-year life table analysis from a prospec-

tive study on ITI implants with special emphasis on the

use of short implants. Results from a private practice.Clin

Oral Impl Res 2004;15:150-157.17. Griffin TJ, Cheung WS. The use of short, wide implants in

posterior areas with reduced bone height: a retrospective

investigation. J Prosthet Dent 2004;92:139-144.

18. Chen ST, Wilson TG Jr, Hammrle CHF. Immediate or ear-

ly placement of implants following tooth extraction: re-

view of biologic basis, clinical procedures and outcomes.

Int J Oral Maxilofac Implants 2004;19 Suppl:12-25.

19. Fugazzotto PA, Beagle JR, Ganeles J, Jaffin R, Vlassis J, Ku-

mar A. Success and failure rates of 9 mm or shorter im-

plants in the replacement of missing maxillary molars

when restored with individual crowns: preliminary re-

sults 0 to 84 months in function. A retrospective study. J

Periodontol 2004;75:327-332.

20. Krennmair G, Waldenberger O. Clinical analysis of wide-

diameter Frialit-2 implants. Int J Oral Maxillofac Implants

2004;19:710-5.

21. Anner R, Better H, Chaushu G. The clinical effectiveness of

6 mm diameter implants. J Periodontol 2005;76:1013-5.

22. Goen R, Bianchesi C, Herzeler M, Del Lupo R, Testori T,

Davarpanah M, Jalbout Z. Performance of short implants

in partial restorations: 3-year follow-up of osseotite im-

plants. Implant Dent 2005;14:274-280.

23. Neves FD, Fones D, Bernardes SR, Prado CJ, Neto AJF.

Short implants- An analysis of longitudinal series. Int J

Oral Maxillofac Implant 2006;21:86-93.

24. Renouard F, Nisand D. Impact of implant length and di-

ameter on survival rates. Clin Oral Implants Res 2006;17

Suppl 2:35-51.

25. Degidi M, Piatteli A, Iezzi G, Carinci F. Wide-diameter im-plants: analysis of clinical outcome of 304 fixtures. J Pe-

riodontol 2007;78:52-8.

26. Misch CE. Contemporary implant dentistry 2000. Anto-

nio Delfino Editore, Roma.

27. Lazzara RJ, Porter SS. Platform switching: a new con-

cept in implant dentistry for c ontrolling postrestorative

crestal bone levels. Int J Periodontics Restorative Dent

2006;26:9-17.



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The option of immediately loading our implant fixtures significantly simplifies the aesthetic and functional solution for patients, in particular when the an-

terior region is compromised. This article presents five cases of immediate loading for the replacement of four periodontally compromised mandibular in-

cisors, carried out using Intermezzo (Megagen Co, Ltd, South Korea) one-piece implants.

Key words: Immediate loading, partial bridges, one-piece implants.

INTRODUCTION

The successful resolution of aesthetic and

functional problems, caused by the loss of

mandibular incisors due to periodontal disease,

by successful combined prosthodontic and im-

mediate loaded implant treatment modalities,

allows a rapid return to normal social life and in-

teractions for our patients. For this reason im-

mediate loading protocols in the aesthetic area

are becoming an increasing part of daily den-

tal practice, reducing the number of surgical op-

erations, treatment time and biological costs

in appropriate cases1-9.

Five cases of immediate loading and restora-

tion of implants for patients ,who presented

with periodontal disease, are presented here.

These patients all had periodontal pockets with

depths ranging from 7 to 11 mm as well as

type II-III mobility of their inferior incisors. One

piece Intermezzo (Megagen Co, Ltd, South

Korea) implants with transmucosal healing

abutments were used. This type of implant was

chosen as they have a narrow abutment and an

emergence profile which aid aesthetics for the

inferior incisor group. In addition, the possibili-

ty of changing the inclination of the abutment

during the surgical phase aided the correct

placing of the prosthesis and its subsequent

restoration.

MATERIALS AND METHODS

The patients, three females and two males,

with an average age of 52.3 years, non-smok-

ers, without parafunctional activity and with a

stable occlusion, presented with a previous his-

tory of periodontal disease. In two cases they

presented with a fractured splint (Fig. 1) used to

try and solve the aesthetic and functional prob-

lem and in three cases presented with severe

mobility of the four incisors (Fig. 2). Once the

patients clinical history and informed consent

had been gathered, a clinical examination and

orthopantomograph (Figures 3 and 4) were

carried out and impressions, bite registrationand facial arch were recorded for preparation of

articulator models with average values. The in-

sertion of 2 Intermezzo (Megagen Co, Ltd,

South Korea) implants, diameter 3.10 mm and

13 mm in length were then planned. In partic-

ular, they were positioned in the area of teeth 32

and 42, with planning for two intermediate units.

Prior to surgery, a dental laboratory was asked

Salvatore Longoni*, Matteo Sartori**, Kwang Bum Park***, Alberto Baldini****, Marco Baldoni*****

Immediate loading of fixed partial bridges:

clinical experience in the anterior mandible

* Specialist in Oral Surgery, Contract Professor in Prostheses,


** PhD research student in Experimental Periodontology,


*** Independent Professional. President of the MIR Dental

Hospital Daegu, Korea.

**** Contract Professor of special odontostomatological anatomy,


***** Head of the Department of Neuro-sciences and Biomedical

Technologies, University of Milano-Bicocca.

Address for correspondence:

Salvatore Longoni

Universit degli Studi di Milano-Bicocca, Via Cadore 48 Monza (MI)

Tel. +39 2 96720909 - Fax.+39 2 96328554



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S. Longoni , M. Sartor i , K . B. Park , A. Ba ld in i , M. Ba ldoni

to create a surgical stent and a shelled tempo-

rary bridge prosthesis that was to be relined

and cemented during the procedure.

Following the administration of local anaes-

thesia with Articaine containing adrenaline 4%

1:100,000 (Ubistesin 3M ESPE, Seefeld, Ger-

many), flaps were created using a intrasulcular

incision; the teeth were removed in the least

traumatic way possible, limiting the separation

of the soft tissues. The implant sites at the lat-

eral incisor site were then prepared according

to the protocol with a lance bur, followed by a

calibrated bur with a diameter of 1.8 mm, a

countersink bur suited to the diameter and the

shoulder of the implant (Fig. 5) and then a cal-

ibrated cutter bur with a diameter of 2.6 mm.

The implants were inserted (figures 6 and 7)

and, if necessary, the axis was corrected by

working on the abutment, not using a bur, but

by bending the abutment with a purpose-made

hand-drive instrument, exploiting the design of

the implant neck. Plastic comfort caps were

then placed on the abutments and the tempo-

rary prostheses were relined in the patients

mouth with cold resin (Sintodent s.r.l., Rome)

(Figures 8 and 9). The space between the plas-

tic cap and the resin temporary prosthesis was

Fig. 1 Patient (I01) with fractured anterior inferior splinting. Fig. 2 Patient (I03) with severe mobility of inferior incisors. Fig. 3 Initial Ortopantomography (Items I01).

Fig. 4 Initial Or topantomography (Items I03). Fig. 5 Use of countersink to determine the correct place-ment of the implant neck.

Fig. 6 Insertion of Intermezzo (Megagen Co, Ltd,South Korea) one-piece implant, diameter 3.10 mmand 13 mm in length.


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filled with a fluid composite (Axia Fluid, Dental-

ica Spa, Milan), while ovate pontics were creat-

ed on the intermediate elements (Figures 10

and 11) penetrating 2 mm inside the post-ex-

traction sockets of the two central incisors. The

temporary prosthesis was then finished and

polished in the laboratory and then cemented

with a non-eugenol temporary cement (Temp

Bond NE, Kerr Italia SpA, Scafati SA) leaving

open flaps, in order to check and remove ex-

cess cement. The papillae were then sutured

using simple sutures with Vicryl Rapid 4-0

(Ethicon, Johnson & Johnson, Brussels, Bel-

gium) (Figure 12).

The occlusion was then adjusted, leaving the

temporary prostheses completely free in protru-

sion and lateral movements. Radiographs were

taken post-surgery to check results (Figure 13)

and the patients were given appropriate post-

operative instructions. The patients followed a

liquid diet for the first week, then a semi-solid

one and hard foods were avoided until after

the fourth week. Use of the anterior teeth had

to be limited for the same period.

The sutures were removed at 10 days and

follow-ups were carried out at 20, 30 and 60

days from loading. The permanent prosthesis

Fig. 9 Relining of temporary prosthesis with cold resin onplastic caps.

Fig. 8 Positioning of plastic caps on abutment.Fig. 7 Inserted implants: the axis of the abutmentswas changed to obtain easy insertion of the pros-thesis.

Fig. 12 Intraoral view of bridge just cemented (Items. I01).Fig. 11The marginal gap is filled with fluid composite andthe ovate pontics are created.

Fig. 10 Removal of temporary prosthesis afterrelining.


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was then completed at a later date. In all cases

there was no need to file down the abutments

in the mouth and the impression procedure

was therefore simplified. The final impression

was taken using a polyether material (Im-

pregum, 3M Espe, Seefeld, Germany) and

plastic impression caps joined with resin (Piku-

plast, Bredent, Senden, Germany). The master

model obtained in this way included the duplica-


tion of soft tissues (Gingifast, Zhermack, Badia

Polesine). A scan was carried out with similar

models and the structure was modelled with the

use of a specific software (Zeno Tec System,

Wieland Dental & Technik, Germany) (Fig. 14).

The final crowns were made with structure in zir-

conium oxide and ceramic and were cemented

with a glass ionomer cement (Ketac Cem ra-

diopaque, 3M Espe, Seefeld, Germany).

RESULTS

During the short observation period of about

eight months on average, no changes in the

quality or quantity of the peri-implant tissues

were observed (Figures 16 and 18). The method

proved to be simple and predictable with great

satisfaction for the patients, as their aesthetic

and functional problems were solved immedi-

Fig. 13 Check-up Ortopantomography (Items I01). Fig. 14 CAD design phase of zirconium structure. Fig. 15 View of prosthesis already positioned(Items. I01).

Fig. 16 Check-up endoralradiography: follow-up at 10months (Items I01).

Fig. 17 View of prosthesis already positioned (Items I03).The excellent emergence profile can be seen.

Fig. 18 Check-up ortopantomography: follow-upat 8 months (Items I03).





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ately from the first session. In particular, the re-

duced size of the implant neck allowed a pros-

thetic emergence that is comparable with the

natural teeth that have been replaced (Figures

15 and 17).

DISCUSSIONAND CONCLUSIONS

The decision to proceed with immediate

loading was taken for the following reasons:

the bone height and bone quality available al-

lowed the 13 mm implants to be positioned

with an insertion torque of 30-35 Ncm;

the patients had normal occlusion and no

parafunctional activity, therefore the dental

units at 32 and 42 received limited occlusal

loads, which were mainly vertical in direc-

tion;

as a result they did not have to bear the

large chewing forces which were borne by

the posterior teeth. Micro-movements could

therefore be avoided, which are harmful for

the formation and maintenance of a stable

bone-implant interface10.

From a prosthetic point of view, the shape of

the abutment, with a neck diameter that is less

than the underlying implant platform, allowed apossible modification of the axis to aid insertion

of the prosthesis. This advantage prevented

the need for modifying and/or shaping the

abutment in the patients mouth which is what

normally occurs in one-piece implants, thus

aiding insertion of both the temporary and the

permanent prosthesis. In addition, the availabil-

ity of plastic caps helps to obtain an excellent

marginal seal of the temporary prostheses and

transfer of the implant position quickly.

To conclude, this type of implant can help to

obtain a quick & simple functional and aesthet-

ic result, but it must be remembered that the

abutment shaped in this way must respect spe-

cific indications of use in the mandibular ante-

rior region or in the superior lateral incisors, in

order to avoid possible risks of fractures caused

by functional overload.

BIBLIOGRAPHY

1. Malo P, Friberg B, Polizzi G, Gualini F, Vighagen T, Rangert

B. Immediate and early function of Brnemark System

implants placed in the esthetic zone: a 1-year prospec-

tive clinical multicenter study. Clin Implant Dent Relat Res

2003;5 Suppl 1:37-46.

2. Calvo Guirado JL, Saez Yuguero R, Ferrer Perez V, Moreno

Pelluz A. Immediate anterior implant placement and ear-

ly loading by provisional acrylic crowns: a prospective

study after a one-year follow-up period. J Ir Dent Assoc.

2002;48:43-49.

3. Glauser R, Ree A, Lundgren A, Gottlow J, Hammerle CH,

Scharer P. Immediate occlusal loading of Brnemark im-

plants applied in various jawbone regions: a prospective,

1-year clinical study. Clin Implant Dent Relat Res 2001;

3:204-213.

4. Malo P, Rangert B, Dvarsater L. Immediate function of

Brnemark implants in the esthetic zone: a retrospective

clinical study with 6 months to 4 years of follow-up. Clin

Implant Dent Relat Res 2000;2:138-146.

5. Achilli A, Tura F, Euwe E. Immediate/early function withtapered implants supporting maxillary and mandibular

posterior fixed partial dentures: preliminary results of a

prospective multicenter study. J Prosthet Dent. 2007

Jun;97(6 Suppl):S52-8. Erratum in: J Prosthet Dent

2008;99:167.

6. Marchack CB. CAD/CAM-guided implant surgery and

fabrication of an immediately loaded prosthesis for a

partially edentulous patient. J Prosthet Dent 2007;97:389-

94.

7. Ganeles J, Wismeijer D. Early and immediately restored

and loaded dental implants for single-tooth and partial-

arch applications. Int J Oral Maxillofac Implants 2004;19

Suppl:92-102. Review.

8. Chatzistavrou M, Felton DA, Cooper LF. Immediate load-

ing of dental implants in partially edentulous patients: a

clinical report. J Prosthodont 2003;12:26-9.

9. Ostman PO, Hellman M, Sennerby L. Immediate occlusal

loading of implants in the partially edentate mandible: a

prospective 1-year radiographic and 4-year clinical study.

Int J Oral Maxillofac Implants. 2008;23:315-22.

10. Szmukler-Moncler S, Piattelli A, Favero GA, Dubruille JH.

Considerations preliminary to the application of early

and immediate loading protocols in dental implantology.

Clin Oral Implants Res 2000;11:12-25.



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